Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
BMC Nephrol. 2021 Nov 4;22(1):365. doi: 10.1186/s12882-021-02577-7.
People with kidney failure have a high incidence of major surgery, though the risk of perioperative outcomes at a population-level is unknown. Our objective was to estimate the proportion of people with kidney failure that experience acute myocardial infarction (AMI) or death within 30 days of major non-cardiac surgery, based on surgery type.
In this retrospective population-based cohort study, we used administrative health data to identify adults from Alberta, Canada with major surgery between April 12,005 and February 282,017 that had preoperative estimated glomerular filtration rates (eGFRs) < 15 mL/min/1.73m or received chronic dialysis. The index surgical procedure for each participant was categorized within one of fourteen surgical groupings based on Canadian Classification of Health Interventions (CCI) codes applied to hospitalization administrative datasets. We estimated the proportion of people that had AMI or died within 30 days of the index surgical procedure (with 95% confidence intervals [CIs]) following logistic regression, stratified by surgery type.
Overall, 3398 people had a major surgery (1905 hemodialysis; 590 peritoneal dialysis; 903 non-dialysis). Participants were more likely male (61.0%) with a median age of 61.5 years (IQR 50.0-72.7). Within 30 days of surgery, 272 people (8.0%) had an AMI or died. The probability was lowest following ophthalmologic surgery at 1.9% (95%CI: 0.5, 7.3) and kidney transplantation at 2.1% (95%CI: 1.3, 3.2). Several types of surgery were associated with greater than one in ten risk of AMI or death, including retroperitoneal (10.0% [95%CI: 2.5, 32.4]), intra-abdominal (11.7% [8.7, 15.5]), skin and soft tissue (12.1% [7.4, 19.1]), musculoskeletal (MSK) (12.3% [9.9, 15.5]), vascular (12.6% [10.2, 15.4]), anorectal (14.7% [6.3, 30.8]), and neurosurgical procedures (38.1% [20.3, 59.8]). Urgent or emergent procedures had the highest risk, with 12.1% experiencing AMI or death (95%CI: 10.7, 13.6) compared with 2.6% (1.9, 3.5) following elective surgery.
After major non-cardiac surgery, the risk of death or AMI for people with kidney failure varies significantly based on surgery type. This study informs our understanding of surgery type and risk for people with kidney failure. Future research should focus on identifying high risk patients and strategies to reduce these risks.
肾衰竭患者进行重大手术的发生率较高，但人群水平围手术期结局的风险尚不清楚。我们的目的是根据手术类型，估计肾衰竭患者在非心脏大手术后 30 天内发生急性心肌梗死（AMI）或死亡的比例。
在这项回顾性基于人群的队列研究中，我们使用行政健康数据，从加拿大艾伯塔省确定了在 2005 年 4 月 12 日至 2022 年 2 月 28 日之间进行主要手术的成年人，这些成年人的术前估算肾小球滤过率（eGFR）<15mL/min/1.73m 或接受慢性透析。每位参与者的索引手术程序根据加拿大卫生干预分类（CCI）代码应用于住院行政数据集，分为十四组手术之一。我们使用逻辑回归估计了 30 天内（95%置信区间 [CI]）索引手术程序后发生 AMI 或死亡的人数比例，并按手术类型进行分层。
总体而言，有 3398 人进行了主要手术（1905 例血液透析；590 例腹膜透析；903 例非透析）。参与者更可能为男性（61.0%），中位年龄为 61.5 岁（IQR 50.0-72.7）。在手术后 30 天内，有 272 人（8.0%）发生 AMI 或死亡。眼科手术后的概率最低，为 1.9%（95%CI：0.5, 7.3），肾移植后为 2.1%（95%CI：1.3, 3.2）。几种类型的手术与大于十分之一的 AMI 或死亡风险相关，包括腹膜后（10.0% [95%CI：2.5, 32.4]）、腹腔内（11.7% [8.7, 15.5]）、皮肤和软组织（12.1% [7.4, 19.1]）、肌肉骨骼（MSK）（12.3% [9.9, 15.5]）、血管（12.6% [10.2, 15.4]）、肛门直肠（14.7% [6.3, 30.8]）和神经外科手术（38.1% [20.3, 59.8]）。紧急或急症手术的风险最高，有 12.1%（95%CI：10.7, 13.6）的人发生 AMI 或死亡，而择期手术的比例为 2.6%（1.9, 3.5）。
在非心脏大手术后，肾衰竭患者的死亡或 AMI 风险因手术类型而异。本研究为我们了解手术类型和肾衰竭患者的风险提供了信息。未来的研究应重点关注确定高危患者和降低这些风险的策略。
